Home' The Source : Third Quarter 2013 Contents [ Spotlight On ]
PARALLON REVENUE CYCLE CONSULTING SERVICES
with its new, unfamiliar rules and regula-
tions. Everyone is stretched thin trying to
keep up with the daily demands, much less
having time to step back and think deeply
about how to improve processes.
The steering committee determined
TRMC lacked sufficient staff and in-
house expertise to tackle what looked to
be a di cult and possibly lengthy job. As a
HealthTrust member, TRMC asked Parallon
Based in Franklin, Tenn., Parallon pro-
vides a full suite of revenue cycle solutions,
including consulting services, management
best practices and customizable technolo-
gies to healthcare providers nationwide.
Parallon's revenue cycle shared services
model is the industry's largest and most
advanced, providing full-service solutions
from patient registration through account
resolution to improve financial performance
and long-term sustainability.
"Many of our billing activities and edits
were ine cient, obsolete or were put in
place without our having a thorough under-
standing of problem causes and how they
a ected the revenue cycle," Scoggin said.
The back o ce sta did not trust the
current system's billing edit function to
catch major payor issues. Instead of em-
ploying an exception-based process, the
sta held all claims for manual review to
catch potential errors that would trigger
rejections and denials.
As a result, the sta poured much of their
time and energy into reviewing the original
claims and could not adequately follow up
on questioned or rejected claims. And the
claims backlog was steadily growing, deny-
ing TRMC much-needed cash flow.
It was obvious the system required a
total overhaul to become more e cient
and e ective, Scoggin said. TRMC also
wanted more business intelligence from
the revenue cycle to improve its overall
Working with the TRMC team, Parallon
identified the most common claim errors that
required manual review and made more than
100 changes to the billing edit process to reli-
ably automate error detection. The changes
were based on the Pareto Principle, often
called the 80--20 rule---that 20 percent of the
claims contained 80 percent of the errors.
The changes gave the sta greater con-
fidence the system would kick out most of
the problem claims automatically, allowing
the rest of the claims to pass on through the
system. This exception-based procedure
greatly increased e ciency.
The TRMC-Parallon team then analyzed
the problem claims and devised automated
solutions that further reduced the number
of claims requiring manual review.
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